With it being so long since I have written for this blog, I thought that instead of writing a piece on a random topic, I ought to tell you about the latest in my recovery process.

In December of 2015, I returned to residency for 3 months to complete my second year of Family Practice medical training allowing me to obtain a Michigan Medical License. After a prolonged battle with our Human Resources, I was allowed to return to residency to complete my second year. After this, I obtained my Michigan medical license. I then shifted my focus onto finding work. I interviewed at numerous positions, where unfortunately, I was told that these jobs ‘were not looking to hire right now’. I contemplated the possibility of opening my own practice, however was discouraged from this by every physician with whom I spoke, “it’s a money pit,” they would say, or simply “it’s really tough to open your own practice. Have you looked into being affiliated with a hospital system?” At this point, I am not sure of the possibility of clinical work in my future. This does not mean that I will not be involved in medicine in my future, but the chance of me working in a clinic, going from room to room, seeing patients is not a strong possibility. I am, however, still considering administrative medical work such as reviewing charts, going over claims, or medical consulting.

Thankfully, veiled in this rejection is the opportunity to spend more time with my family. Before the surgery, I saw my wife and son sparingly. I would spend nights at the hospital and only come home to sleep. I would miss events like sports games or school conferences. I now attend every sports game and school event and am even able to drop and pick up my children from school. I also have dinner ready every day when my wife returns home from work, and have been able to enjoy cooking, another previous interest of mine.

This ordeal has also allowed me to focus on writing; perhaps I had little or no time to write prior to my surgery, or maybe my love of writing was born after my ordeal, but I have been fortunate enough to have two of my pieces printed in the American Family Physician journal and the International Brain Tumour Association journal. (AFP: http://www.aafp.org/afp/2016/0601/p911.html, IBTA: (page 58) https://issuu.com/ibta-org/docs/ibta_2017). Writing provides me with some catharsis. I hope my writing also imparts on you similar sentiments.

Physically, I continue to improve, however my attitude and approach to my recovery has changed. I have discontinued Physical Therapy, however spend much of my time in the gym doing balance exercises. Many loved ones around me have asked me if I have ‘given up’ on the possibility of further recovery. My response is this:

While yes, the optics of my rehabilitation have vastly changed, I continue to fight, albeit in a different way. In the recent past, I participated in Physical, Speech, and Occupational Therapy. I now have stopped these sessions, as I had to ask myself, ‘is Therapy worth it? Is it worth my time and sweat (over 15 hours each week) for the possibility of return?’ The Economist in me is shining through when I question the futility of pursuing an object with uncertain returns. But this does not mean I have ‘given up’; as I mentioned above, I continue to strive to work to beat this, but not blindly working, working smarter. The saying ‘practice makes perfect’ is often preached to anyone pursuing an endeavor. Allow me to take this a step further: it is not practice that makes perfect, but perfect practice that makes perfect. For example, I could spend 100 hours a week on my golf swing, but will I be a better player if I practiced all these hours with poor technique on my swing? Of course, the answer is no, in fact one could argue that I could emerge a worse player. Now, imagine that I instead spent that time practicing with a picture perfect swing. I would undoubtedly end up a good (if not great) golfer. My hope is that with my recovery, I am practicing now with ‘perfect technique’; in the sweet spot that will make my recovery optimal. While I have stopped the official Therapy sessions, I continue to devote much of my time performing the exercises I learned during my time with them. In addition to these physical strengthening exercises, I also work on keeping my mind sharp by reading and writing often. While the appearance of my recovery may seem slowed, I continue to work hard. Unfortunately, only time will tell if I am truly practicing ‘smarter’, as there is no precedent to my condition.

I am by no means saying the Therapy is an inviable means of rehabilitation. On the contrary, this experience has shown me the importance of therapy; I used to write many prescriptions that read, “Physical Therapy 3 times per week,” and while those were not completely empty recommendations, I now fully realize (after having gone through therapy myself) how important therapy is in a wide range of diseases and afflictions. My only point is that for me, at this stage, no one knows if going through Therapy will aid my recovery. My thinking is that the way I recover now is the best way I can pursue rehabilitation, at this stage.

We often look for hidden lessons in our experiences; my first hope with this piece is to provide you with information of my recovery. But the idea that perfect practice makes perfect is an important one. Anyone can practice, but to practice perfectly is the only true metric to obtain excellence.

ne of the reasons I have not produced anything for you is that for the past several months I have been back in the clinic seeing patients, completing a portion of my family medicine residency training. As part of this training, once a month we have a 2 ½ hour seminar as part of our behavioral medicine curriculum. During this time we discuss a wide array of topics ranging from bipolar disorder to child abuse, all with the aim of improving our communication skills, and hopefully help us become more empathic physicians. One of the past sessions we were treated to a fascinating lecture on a less well known personality classification scheme. Most of us have heard of the Myers- Briggs test, where after an extensive set of questions, spanning many hours, you are given a set of 4 letters denoting your personality type. For example, you might be told that you are an ‘ESTJ’ meaning you are an extrovert, sensing, thinking, and judgment type. While I think this can be a helpful schema, my issue with it is the time required to take the test. During our session, rather than the Myers-Briggs test, we were given a different and much shorter personality test (it literally took me 7 minutes to complete) and based on the results were given a color that matched your personality type. I have included a copy of this questionnaire below, I encourage you to try it:

Personal Style Inventory

Robert W. Russell, Portland, Oregon

Used by permission

Each line below lists two contrasting traits. Your task is to spread seven points between the two statements on each line to reflect the balance of how each best describes you. Points may be spread in any way you wish, but both sides together must add up to seven. Give high points to the description that describes you well, while giving the other side low points. For example, people who see themselves as quick in the way they handle things, might fill out the first line like this:

Add up the total number of points for each column (A, B, 1, and 2). The columns (A/B and 1/2) with the highest points determine your color.

Highest A and 1 = RED

Highest A and 2 = BLUE

Highest B and 1 = GREEN

Highest B and 2 = YELLOW

For example, a ‘red’ is a very assertive person, a type A personality. A ‘green’ is very task oriented, they are the thinkers. A ‘blue’ is very compassionate and detail oriented. A ‘yellow’ is more of an introvert, and always follows the rules. I have also included a copy of the interpretation sheet and what the various colors mean:

PEOPLE ORIENTED, EXPRESSES OPINIONS AND EMOTIONS EASILY. IS VERY ACTIVE AND MOVES AT A LIVELY PACE. PREFERS STRONG INTERACTION WITH PEIOPLE. USUALLY HAS MANY INTERESTS. TENDS TO BE IMAGE CONSCIOUS.

COMMON STRENGTHS: Personable, stimulating, enthusiastic, dramatic, inspiring, innovative, articulate, concern for the welfare of others. Looks for ways to be helpful, friendly, tries to avoid being a burden to others, warm-hearted.

DATA ORIENTED, LIKES THINGS TO BE WELL ORGANIZED AND THOUGHT OUT. PREFERS SPECIFIC PROJECTS AND ACTIVITIES THAT CAN BE SYSTEMATICALLY WORKED ON. ENJOYS PUTTING STRUCTURE TO IDEAS. THOROUGH AND CAREFUL ABOUT DETAILS.

Personally, before this lecture I despised personality tests; I hated the idea of being labeled and I also frequently find flaws in their findings. Yes, that’s true about me I will think, but this is definitely not like me. This test was different though, while yes it did label me as a certain personality, it was also incredibly accurate. Every bullet point that described my personality, my ‘color’ was true.

But what was the purpose of this test? For us, it helped us better understand ourselves and others, and hopefully will aid us in our interactions with colleagues and patients. But why should that exclusively help physicians? All of us have our color, knowing it will not only help us become more self-aware people, but it will also help us better understand others and where they are coming from. For us, even though we share the commonality of either suffering from Epidermoid Tumors or having a loved one afflicted with the condition, we are all individuals, different people with different personalities. It is impossible for any personality test to be 100% accurate, they are simply aimed at classifying your personality with few errors. For me the accuracy of this test was striking, with such little preparation time. More importantly, it highlighted to me the importance of self-awareness and how all of our interactions with others can be made better with this understanding. Take the test, find out what color you are. What color would you label your loved ones? Are there certain colors you are drawn to? For me, I turned out to be a ‘yellow’ with my wife being ‘green’. But I realized that a team filled with either yellows or reds would not make an effective team—you need diversity in colors to make a good team. Tell me what color you are, and what color your loved ones are.

In the last post I talked of my former college tennis coach, David Fish. When I was in school, I, we would often lament any perceived misfortune. It got to the point that any net cord or any bad bounce had us asking “why?“ as if we were talking to Lady Luck, questioning her choices. Coach had obviously heard enough of our constant feeling of “luck not going our way” and told us a poignant story that sticks with me to this day:

There once was a farmer who needed his horse to till his fields. One morning this horse ran away, prompting his neighbors to sympathize and lament his misfortune. The farmer’s response was “Bad luck? Good luck? Who knows?” Sometime later, the same horse returned with a herd of wild horses. His neighbors congratulated him on his good luck. The farmer’s response again was “Bad luck? Good luck? Who knows?” Then, when the farmer’s son was attempting to tame one of the wild horses, he was thrown from one of these horse’s back, and broke his leg. Everyone felt bad for the farmer and his son for his bad luck. Again, the farmer’s only response was “Bad luck? Good luck? Who knows?” Several weeks later, the army came to their village and ordered for every able bodied to enlist. However upon seeing the farmer’s son and his leg in a cast, they asked that he not ‘volunteer’. Was this good luck? The story could go on endlessly.

However, the point of him telling us that story was so we would not be so short sighted as to decry every perceived instance of misfortune as ‘bad luck.’ As we learn from the story, what is deemed as ‘bad luck’ cannot be truly labeled as such. Who really knows?

I have thought much of this story since my surgery, as on the surface it may seem as if I have had ‘bad luck’. Before the surgery I was a fully functioning, tennis playing, physician-in-training, and now even traversing a small curb is treacherous. One might take one look at me and think bad luck. But my response would be “Bad luck? Good luck? Who knows?” The reality is that none of us are fortunetellers, no one knows what the future holds, so no one truly knows how everything will turn out. Yes, maybe on my deathbed I’ll think boy that brain tumor was really bad luck, or maybe I’ll think I sure was lucky to get that brain tumor. This is not only exclusive to my situation and me, but is universal as well. Remember that the next time you think to yourself that was bad luck, and instead think bad luck? Good luck? Who knows?

I hate to waste your time and write about dreams I have had, but this dream was too poignant to pass up; it taught me a valuable lesson that I wanted to share with you.

As I mentioned prior, I played much tennis growing up and played on the university team for my 4 years there. The coach of the team was (and is) a man by the name of David Fish; a man who was once on both the tennis and squash teams. Since my graduation in 2004, I have kept in (sporadic) touch with him, trading e-mails reminiscing about the past. I often think back to my days on the tennis team: my thoughts always go back to the camaraderie shared with my teammates and the joy that came with playing the sport. Sometimes when I think back to these ‘good ol’ days’ I cringe at my obvious immaturity, squabbling over insignificant issues like lineup placement or doubles partner choices. My thoughts then return to Coach Fish and I find myself appreciating his job in ways I had not before: not only did he have to manage the lineup to make sure the team he put forth optimized our chance of winning, but he also had to manage 12 young, immature men; all of whom wanted to play more and were only just out of high school. The reason I tell you this is so you can maybe better understand the relationship I share with Coach. I want you to understand this relationship so when I tell you of this dream you have a better context for it.

Maybe 2 weeks ago I had a dream where I was conversing with Coach. As with most dreams, there is no beginning or end, I somehow appeared with Coach (almost in mid conversation); and just how there is no segue into the conversation, it ended mid conversation when I awoke. I usually awake from my dreams and do not remember them. I do however, remember my conversation with him. Somehow, the issue of my health was brought up. I remember then telling him, “Coach, I miss running.” I then began crying, longing for the days where chasing down a drop shot[1] was simply second nature to me, where issues like running and balance did not cross my mind. Even though this was a dream, that feeling of longing was real. I tried but I could not hold back my tears, I missed this ability so much. The cry was so strong that I found myself crying when I awoke. Tears come to my eyes now just thinking of the dream.

Drop Shot Diagram

I find myself longing for the days where running and cutting was second nature to me. This comes in stark contrast to now where every step I take is an unsteady one. It has taken me almost 3 years but I now realize that the days of chasing down tennis balls are forever behind me. Although I don’t want you to think that I am surrendering or giving up, for me it is simply an ability that I once had that is now gone.

That dream made me realize though that instead of wishing and longing for these abilities, that I should be thankful for what I am still able to do. I think that, unfortunately, part of nature is to wish for things we don’t have; this could be something as straight forward as more money. But instead of wasting our time focusing on what we don’t have and want, wouldn’t our time be better spent thinking and grateful for what we do have and can do? This lesson for me was only highlighted by this dream. Because a seemingly straight forward ability was taken from me, I found myself falling into the trap of hoping and wishing for something I did not have. It took a 16-hour surgery and months of rehabilitation for me to realize this. But remember, do not waste your time desiring something you do not have, instead be grateful for what you do have. The old adage that the glass is half full and not half empty, should remind us that there is always a silver lining to whatever situation we find ourselves in.

[1] For you non tennis players, a drop shot is when either you or your opponent hits a shot purposely short and soft in hopes of catching you off guard, and having the ball bounce twice before you can get to it.

The past few weeks I have noticed that my memories are now framed in the context of its temporal relation to the discovery of my tumor. Because I have been told that this was a slow growing tumor, one that was probably present at birth, even experiences I recall as a child are now thought of in relation to this mass in my brain until finally at age 31 the tumor grew big enough to cause the double vision that prompted my diagnosis. It’s almost as if I was living with a time bomb in my head.

I remember at age 9 playing against one of the top tennis players in the state, and losing in three sets. I remember being torn apart by the loss. By nature, I am not competitive with others. I am competitive with myself. This particular loss did not hurt me because of who I lost to, but because I felt it was a reflection of my shortcomings; maybe if I had practiced longer or hit my forehand better, I could have won that match I thought. I recently thought of this match; however this recollection ended with the thought that the tumor was growing then.

Tick Tock

I had a flashback to my days in college; leaving my mom and step dad for the first time was traumatic for me. I cried and cried after leaving them. My roommates, now my close friends could sense this distress as each and every one of them tried to cheer me up (with lots of alcohol). I remember nervously calling this girl (my now wife) to ask her to an event a college club was hosting. Luckily, she took my invitation. Every time I look at my wife, my mind drifts back to the days of college, unfortunately I now also think of those days as not only great experiences but I point out to myself that the tumor was only years away from its 4.5 centimeter size as found during surgery.

Tick Tock Tick

When I step into Sparrow Hospital, my thoughts do not automatically converge on my month long post-operative stay there; no actually I first think of my days there as a first year resident. I remember being scared of the idea of treating and managing patients. The exhaustion that came with the long hours spent at the hospital, the overnight shifts that made up intern year is a feeling that’s hard to forget. I do remember the knowledge that I gained with experience. I remember thinking, I know this. I can handle this. As I transitioned from intern year to second year my fear turned to confidence, as I felt with my knowledge and experience that I could handle anything thrown my way. When I have this nostalgia to the early days of my residency, I cannot help but think that the mass in my head was nearly fully grown by then.

Tick Tock Tick Tock

Then on Monday morning March 18th of 2013 I awoke with double vision.

Boom.

The rest of my memories are now reflected on as times with the tumor out of my head.

I hate to liken this tumor to a bomb in my head as it didn’t kill me; but I cannot deny that it changed everything forever. I cannot help to impart to you that this ordeal has taught me that we should cherish every moment we have. As clichéd as this is, I literally went from fully functional to handicapped overnight. I am lucky that I lived my life with no regrets, and that when I remember these events, even though these memories are jaded by the thoughts of the growing mass in my head, I regret none of them. My message is to remind you to do what makes you truly happy and appreciate every moment along the way: life is fleeting and that it can all change overnight.

In dealing with my ordeal I have come to the realization that the idea of prejudice is important and I was hoping to share my thoughts on this with you.

I grew up in Omaha, Nebraska. In my high school there were 500 students in each class, coming to a grand total of about 2000 students in the school. Why do I tell you this? Excluding myself, there were about 5 other Asians in the entire school and 2 or 3 African-Americans. The rest of the 1,992 students were Caucasian. The make-up of the community was the same. One would think that in my upbringing these numbers might lead to prejudice and racism. Surprisingly, with the exception of the odd comment here or there and the scarce incidents, my memory of growing up in Omaha is not filled with racist encounters; in fact I have a hard time remembering any incidents that stemmed from my race. This is not to say that prejudices did not exist in Omaha. The more I reflect on it, the more I realize that while the prejudice was not overt it was still present. When people saw me they automatically made some assumptions. Perhaps they thought, “I bet he’s good at math” (unfortunately I am not) or “He is probably a bad driver” (which I am), or simply insert any of your preconceived notions about Asians here. I do not think these thoughts make you a bad person, in fact many of these thoughts are simply a product of evolution: if I were to come across a grizzly bear in the forest, I would (quickly) assume it’s dangerous and that I should run. These assumptions are engrained in my DNA and allow me to survive. I realize that this is a fine line I’m walking: on one side intuitively we know that prejudice can be detrimental and that incorrect assumptions can lead us astray; but on the other hand I tell you that some degree of these assumptions is not only okay but imprinted in our genes. I hope you do not come away from this post thinking Chris said it was okay to be a racist. My point is simply that there is a fine line we must walk between overt, detrimental racism and useful assumptions. Anyhow, I digress. Growing up I did not deal with overt racism but instead, hidden prejudices.

This is significant because I realize that now more than ever; I am constantly fighting preconceived notions about myself. This is ironic because none of these beliefs are due to my race: when I hobble across the hallway to introduce myself to someone, the first impression is not I bet he went to Harvard, played professional tennis, and is a doctor. I’m not going to pretend I can read the minds of every passer-by and guess their first thoughts of me, but I assume that many may question my cognitive abilities. This constantly puts me into an uphill battle whenever first meeting someone. As a physician I have to convince patients that my cognition is intact and that I can help them. As a human being, if someone were to see me in the grocery store and assume that my physical disabilities imply I am mentally handicapped as well, it would be easy for me to think defensively, “They can think what they want, I don’t care.” But as a physician I do care what patients think of me. That is why much of what I do is aimed at dispelling any of these beliefs.

My hope is that when you meet someone, even though your mind may drift and make some incorrect assumptions (my aim is not to erase these beliefs that may deeply engrained) that you try to get to know this person. You may find out that everything you assumed is correct, but you most likely will discover that your thoughts misled you. For me, I will continue to battle any preconceived notions about me, a battle that I did not know existed, but has been ongoing since my childhood in Omaha.

When I first began this blog I had hoped for a full recovery; my neurosurgeon told me many times that he expected a full recovery, “You’ll be better than before,” he would tell me at my appointments. I would cling to his expectations so much so that even over two years post-surgery, and still hampered, I thought I might still recuperate to my baseline: in fact, I would often tell friends, “My neurosurgeon told me that he expects a full recovery.” Most often I would get a reaction of first disbelief, then of acceptance, as if they are being told that Jupiter is over 350 million miles from Earth. The first thought is no that can’t be right, followed by well, if the experts say so, it must be true. Who are we to question a neurosurgeon or an astrophysicist?

Last year I had the pleasure of meeting Brian and his lovely wife Jess. I was introduced to them through my physical therapist, Cheris. When Cheris told me about them, the parallels in our stories astounded me: Like me, Brian underwent an extensive brain surgery, and their child was born while still in the hospital while he was still recovering from the surgery. I would occasionally run into Jess and Brian at the YMCA with both of us trying to rehabilitate. I remember on one of these occasions the topic of recovery came up. He was told by his neurosurgeon to expect this or that x number of days after the surgery. I told him, “Brian, they can give you figures and numbers, but the truth is, we are both on unchartered territory and gauging recovery is guesswork at best.” I realized later how cynical this came across; I sent an e-mail to Brian and Jess expounding on my statement—I explained that I by no means meant to diminish their hopes of recovery; on the contrary, I meant to raise their spirits—I have been told by numerous clinicians that most to all of my recovery will take place in the first year, but I still experience small gains to this day, over 25 months after the surgery. My point was that even though medicine is rooted in science, and we know the mechanism of a heart attack to a molecular level, everyone is different and we cannot say for certain how someone might recover from this insult. In medicine, we are expected to give our predictions: predictions of a disease process, prediction of a cause of ailment, even predictions surrounding life span and even though these predictions are scientific in nature, whether it be rooted in research studies or clinical experience, they are still predictions. And we ought to accept them as so. One of my supervising physicians once poignantly told me, “Chris, when someone is on a medication, we can predict what the medication will do in their body. When someone’s on five or ten medications, then we can kind of predict how those medications will interact with each other and the host. When they’re on fifteen or twenty medications, then we have no idea what’s going to happen.” I don’t tell you this to tell you to stay away from medications; I simply feel it highlights the idea even though medicine is part science it is also exploration of the unknown, and I think that is sometimes forgotten.

Uncharted territory

What does this have to do with my condition? Even though at first I had hoped for a full recovery, meaning one day you could see me jogging down the street while on the phone (speaking in a normal voice) I now realize that my condition is permanent. But like my first statement to Brian and Jess, I do not want you to misconstrue my words to mean I surrender—on the contrary I hope to convey a message of hope. I have now come to the realization that my condition will stay as it is. Even though I do experience small gains every day and I do still hope to improve and progress, I have come to terms with the idea of never walking and talking normally again. I realize that this tumor has left me with deficits, deficits that make most seemingly routine activities difficult. But even though this tumor has stripped me of many of my abilities, without it I would not have discovered my love of writing, the importance of my family, and the beauty of medicine. Ironically, while this tumor has taken much away, it has also given me so much.

I am incredibly lucky to have my older sister, Amy Aminlari, to edit each and every one of my pieces. Not only is she an Emergency Department physician and mother of three, she is also a brilliant writer, graduating from Yale University with a degree in Political Sciences. Most importantly to me, she is one of my best friends, whose love and encouragement has allowed me to get through this. Since the beginning of this ordeal, she has constantly been telling me to expect a full recovery. When I sent her this piece to read over, she told me that while the piece was grammatically sound, that “I hope you haven’t given up hope that you can still improve. This makes me sad.” I e-mailed her back and told her that my aim was not to paint a picture of “giving up,” but that while I have accepted my limitations, I will work to not hide or disguise my shortcomings, but to show off my strengths. Even though this tumor accentuates these shortcomings (unable to walk or talk right), it has also allowed me to explore and highlight what I can do. Yes, five years from now, I have accepted that I will still have disabilities, but five years from now I also hope to have developed what I can do.

In medicine, we are constantly trying to make progress in the field. We achieve this through various mediums: new methods to teach medical students and residents, innovative technological procedures, and even what we call “M and M” (Morbidity and Mortality, a conference during which a case is presented and there is a discussion about what went wrong—usually a negative outcome for a patient). In these M and M’s a misstep in the typical sequence of events occurs, resulting in a poor outcome. People spend hours at these M and M’s in an attempt to decipher where this ‘misstep’ occurred. 95% of the time, mistakes can be traced back to a breakdown in communication. I recently attended a lecture at which the tragic story of Jose Martinez was shared.[1] I will attempt to give you a brief summary of the unfortunate events that led to Jose’s death (although I encourage you to read the article if you can): after being diagnosed with a heart condition, Jose underwent surgery in an attempt to help his ailments. In his recovery, a medication called Digoxin was to be administered. While the Digoxin dose is standardized for adults, it is a medication rarely used in pediatrics. Through a calculation error that was reviewed multiple times prior to administration Jose was accidentally given a dose of digoxin over 10x the typical dose. The immediate knee jerk reaction is to try and ascertain who is at fault. Who can I blame for this? The answer is not so simple. Even though the initial dosing error was made by the physician, the numerous checks in place after the initial mistake should have prevented and caught this error. The bottom line is that an improvement in communication could have averted this tragedy. Improved communication is a vague idea: perhaps if the nurse and physician discussed this dose further the mistake could have been avoided. Or if communication between the pharmacist who dispensed the medication and the receiving nurse were better, Jose would be alive today. Determining the crucial point at which this communication broke down could result in endless hours of speculation. Ultimately, it is miscommunication that led to Jose’s premature demise.

Now, this is not a novel idea: improving communication is a notion that has been prevalent for centuries. What does this idea have to do with my situation? Ironically, even though some of my communication skills were strong before this ordeal, I now realize that I have long depended on verbal communication as my sole means of communication. In today’s age there are countless ways to communicate: e-mails, texts, (snail) mail, telephone, and even Facebook. There are also more classical ways to communicate: face-to-face exchanges, interpreting of body language, and perhaps most importantly, listening. Even though my verbal communication has been hampered, this deficit has allowed me to focus on and strengthen other modes of communication. It is akin to someone who has lost their sight; in most of these cases their other senses become heightened. I hope that in my case that this ‘loss’ of verbal communication has enhanced my other modes of communication. In many ways, I consider myself lucky to have the deficits I have at this time in history. I say ‘in many ways’ because I often imagine my fate if this were to occur even 100 years ago. First off, medicine would not have been at its current stage, and if I went to my doctor with the complaint of double vision, a good doctor might have said, “Well, it’s probably a brain tumor, but there really is no way to treat it even if it is.” His (or her) empathy wouldn’t allow him (or her) to tell me that I’d simply have to wait to determine if there is progression; in essence I would be forced to await death. Let’s say for this hypothetical situation, my condition was somehow treated but left me with these current deficits; remember this is before the advent of luxuries like Internet, or even – gasp – smartphones excluding e-mails, texts, and Facebook. Even though I realize that I have suffered an unfortunate fate, part of me feels incredibly fortunate for this to have happened when it did.

I know that one article may not be able to prevent all consequences of miscommunications, however, I believe today technology should serve to bring us closer together and allow us to communicate more clearly. Even with these advances, it seems intuitive that we should become closer to our fellow man, but in reality we have become more distant from each other. In my mind, I imagine a couple at dinner engaged not in conversation, but with their phones, sending e-mails and texts—perhaps checking their Twitter feed. Is this now the only way to communicate?

This article is dedicated to a dear friend of mine, Kyle Snell. Kyle is one of my closest friends and visited me every day I was in the hospital. Ironically, Kyle is an amazing athlete, completing the Boston Marathon, twice. I call this ironic because, even though athletics used to be a major part of my life, I now even struggle to walk. Kyle is now completing a fellowship in Sports Medicine, but was once a resident physician in our program. I had hoped to practice with him. I dedicate this article to him because I often think of his situation and this analogy.

In life we are constantly trying to juggle. What we juggle and how much we juggle varies from person to person; for example, there are some of us that are juggling light handkerchiefs. On the other hand there are some of us who try to juggle flaming bowling pins; some of us juggle two things at a time, while others try to juggle five or six items at a time. There is no right or wrong way to juggle. For some, juggling lighter items makes life bearable, for others juggling many things at a time is the way to go. The key, like everything else in life, is to find the right balance; you need to figure out what works for you, what you can handle.

This topic is apropos due to both my recent change in situation and in giving advice to a good friend of mine. In the latter situation, my friend, who had entered into a new relationship was at a crossroads and wondered if taking the next step (i.e. marriage and children) was prudent. I gave his question much thought and came to the conclusion that adding more to his plate now may cause him to neglect something else in his life. I then gave him the analogy of juggling, which I’ll share with you; for me, this ordeal has highlighted the idea of juggling and ultimately the limits with which we ought to give ourselves when trying to undertake something new (or perhaps something old). In my specific case, ‘the balls’ I juggled were family, friends, medicine, and exercise. I did not realize this, but before my surgery, medicine was a very large, heavy ball while family (even though at the time I thought it to be a ‘large ball’) was in fact more like a tennis ball. Since the surgery I have become increasingly focused on my family; and by this analogy it would be represented by a basketball now.

For my friend, I warned him that adding another ball to his juggling act (or more accurately adding more weight to what he is juggling) could produce disastrous results, for he may neglect something he was keeping in the air and inadvertently ‘drop it’. I had decided that for him, his juggling act was already in delicate balance and I feared that adding anything else would end up in a ‘dropped ball. I knew that for him, he always gave everything he has (and more) to whatever he decided to ‘juggle’ and that adding yet another item to juggle wasn’t a good idea. Thankfully, he took my advice and did not pursue anything further. I recently saw him and he seems happier than ever, and content with his decision.

I’ve come to the realization, however, that this juggling analogy not only pertains to both his situation and mine, but to everyone’s. We all have issues that we are metaphorically juggling. Knowing what you are juggling can help you to make decisions whether to undertake something new. That by no means implies you should stay away from new activities; just know that this juggling act is a delicate balance—as I was told “only you know what it’s like to walk in your shoes.” Only you truly know this balance and what you are capable of juggling.

We all like to think of ourselves as someone who works alone, a lone ranger. In fact, the term ‘lone ranger’ comes from a popular television series, based on a novel, in the 1950s. Now, calling someone a lone ranger is synonymous with deeming them as someone who needs little or no help; someone who is completely self-sufficient. What people often forget is that the Lone Ranger needed the help of Tonto. I tell you this because it highlights the fact that everyone needs help; no one gets where they are without it.

In my current condition, I’ve come to realize the importance of the aid of others. As physicians, we are often presented with cases that are beyond the scope of our skill set: at that time we ask for ‘help’ from consultants and specialists. No matter what branch of medicine, there are always times in which a consultation is needed: for example, if a 50 year-old woman with a history of urinary problems goes to her Urologist’s office for these urinary problems, but reveals that she has been coughing up significant amounts of blood; the Urologist would say, “You should be seen for that in the Emergency Department (ED).” The ED physician, after evaluating the patient, might enlist the expertise of a specialist, a Gastroenterologist. The Gastroenterologist might in turn, need the help of the patient’s Family Doctor to manage her high blood pressure or diabetes. My point in this convoluted scenario is that everyone in medicine needs help; the ‘lone ranger’ is an antiquated notion that is simply not realistic. This idea, I’ve realized, goes beyond the practice of medicine. We all need help.

Before my ordeal, I was always reluctant to ask for help. I aspired to be a ‘lone ranger’. In fact, I have mentioned before that I initially began my training in the specialty of Emergency Medicine (EM). I then switched to Family Medicine after one year of EM training. I have many reasons for this switch, but one of the main reasons is that when I entered into Emergency Medicine, I was hoping to be in a specialty of medicine that required little assistance from others. After being in the ED I realized this wasn’t the case: actually most cases required the aid of others. This trait of mine became magnified immediately after my surgery, as I hated the idea of asking for help. Even asking my assigned nurse for medications for pain was difficult for me. After my discharge I continued to be reluctant to ask for help. Not only did I still have my lone ranger mentality, but also I viewed the acceptance of help as an exposure of my weakness. I feared that accepting help put my disabilities on display. Thankfully, time has shown me the error of my ways: I now have no issue in asking for help. This can be as simple as allowing someone to hold a door for me (where every instinct in my body tells me to open doors for others) or as complex as accepting help in returning to work. It is called ‘help’ for a reason: this act is in service of another. The scale of this might differ: a person helping someone cross the street might ‘help’ on a smaller scale than Martin Luther King, Jr. uniting a whole race. To me, help is help, whether the act is a big or small one. In this example, I see both as reaching in the same areas of their heart to help, and regardless of the scale, I’ve realized that no one gets where they are without some help. All people who achieve success on any level have great people behind them. The help I ask for might seem minor, but my acceptance of help in these instances signifies my willingness for assistance in other grander issues.

We all need help to achieve our goals. Great people accomplish great things only with the help of those around them. Have you accepted the fact that you sometimes need help?